STAMPED & REDACTED - FOR AGENDA ATTACHMENT - MAUREEN MCGINN.PDF
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Maricopa County Human Resources Memo To: Juantia Garza, Clerk of the Board at From: Zell Bullis Date: January 4, 2024 4 Wd h- NYP 7202 Re: Replacement of Lost Payroll Warrants 2 Please find attached _1 __ Affidavit/Notice of Claim(s) for lost payroll warrants for inclusion on the next available Board agenda. The attached item(s) have been researched to ensure that the warrant(s) in question have not been cashed or previously re- issued. The original warrant(s) have had a stop payment done. Please call Zell Bullis at ext. 60409 for any questions. Please route approved Affidavits back to County Payroll, 8" Floor. Stale Dated Warrant Duplicate Warrant Thank you. ge Replacement Lost Warrant Form 1 08/02/2022 Application for a Duplicate or Stale-Dated Warrant/Check Affidavit/Claim Form This application is for: Duplicate or LJ stale-Dated (definitions are on paye 2) STATE OF ARIZONA Note: Numbers on this form correspond to numbers on the , COUNTY OF MARICOPA Instruction sheet which is page 2 of this form. | Maureen McGinn (1), being first sworn, upon oath deposes and says: Name/Claimant On or about 11/22/2023 (date)(2) a warrant/check was issued to the above named person/entity in the amount as stated below. Such warrant/check was either never received or was subsequently inadvertently lost or destroyed and there is no reasonable probability of its being found or presented for payment, or it was not presented for payment within one year after the date of issuance. Therefore, under penalty of perjury, claimant hereby affirms that this claim is correct and the amount shown is due and owing, and the applicant requests that a replacement warrant/check be issued to him/her in the sum of $1097.25 (3) Signed: Metre YW. Wf sual (4) Note. Please attach a copy of the warrant/check if available and/or any other evidence that a warrant/check was originally issued. i (5) Subscribed and sworn to before me this_2.8™ day of Decemoty 20 24. NOTARY PUBIC My commission expires: 7 q O71] 312074 (seal) Warrant/Check Number (if known) (6) 52776186 Original Date of Issue (if known) (7) 11/22/2023 Reason for original issue of Warrant/Check (8): iv] Payroll L For Services or Goods furnished L_Itreasurer's refund/payment LJother: 1/04/2024 Revised April 2015 Maricopa County 301 W. Jefferson St. Suite 800 Phoenix, AZ 85003 +1 (602) 5063519 Eamings Maureen Moginn lame : Company g ae Pay Period Begin} Pay Period End Check Date} Check Number| iMaureen Mcginn laricopa County 10/30/2023} 11/12/2023) 11/22/2023) ee _ Hours Worked] _ Gross Pay| Pre Tax Deductions] —_ Employee Taxes} Post Tax Dedu __Net Pay| Current 0.00) 1,097.25 0.00 0.00 0.00 4,097.25 YTD 0.00) 1,195.25) 0.00) 0.00 0.00) 1,195.25 E ae = _ Eamings fee ees = E z So ‘Description Dates Hours Rate Amount YTD Hours YTD Amount ‘Central Board Workers 14 40/30/2023 - 11/12/2023 66.75 14 934.50 73.75, 1,032.50 Central Board Workers 14 OT 10/30/2023 - 11/12/2023 7.75 44 162.75 7.75 162.75 1,097.25 4,195.25 Amount YTD! (Description Federal Withholding - Taxable Wages 1,097.25 1,195.25 State Tax Taxable Wages - AZ 1,097.25 4,195.25) a as ___ Federal _ State! Marital Status Single or Married filing separately! (Allowances 0) 0.00% Additional Withholding 0) 0 Payment Information - = USD Amount Amount Bank Account Name Account Number 1,097.25 USD (Check)